Infectious complications of percutaneous central venous catheterization in pediatric patients

Objective: Analysis of infectious complications and risk factors in percutaneous central venous catheters. Design: One-year observational, prospective, multicenter study (1998-1999). Setting: Twenty Spanish pediatric intensive care units. Patients: Eight hundred thirty-two children aged 0-14 years. Intervention: None. Measurements and main results: One thousand ninety-two catheters were analyzed. Seventy-four (6.81%) catheter-related bloodstream infections (CRBSI) were found. The CRBSI rate was 6.4 per 1,000 CVC days (95% CI 5.0-8.0). Risk factors for CRBSI were weight under 8 kg (p < 0.001), cardiac failure (RR 2.69; 95% CI 1.95-4.38; p < 0.001), cancer (RR 1.66; 95% CI 0.97-2.78; p = 0.05), silicone catheters (RR 2.82; 95% CI 1.49-5.35; p = 0.006), guidewire exchange catheterization (p = 0.002), obstructed catheters (RR 2.67; 95% CI 1.63-4.39; p < 0.001), and more than 12 days' indwelling time (RR 5.9; 95% CI 3.63-9.41; p < 0.001). Multivariate Cox regression identified lower patient weight (HR 2.4; 95% CI 1.11-5.19; p = 0.002), guidewire exchange catheterization (HR 2.2; 95% CI 1.07-4.54; p = 0.049) and more than 12 days' indwelling time (HR 1.97; 95% CI 0.89-4.36; p = 0.089) as significant independent predictors of CRBSI. Factors which protected against infection were the use of povidone-iodine on hubs (HR 0.42; 95% CI 0.19-0.96; p = 0.025) and porous versus impermeable dressing (HR 0.41; 95% CI 0.23-0.74; p = 0.004). Two children (0.24%) died from endocarditis following catheter-related sepsis due to Stenotrophomonas maltophilia in one case and P. aeruginosa in the other. Conclusions: Catheter-related sepsis is associated with lower patient weight and more than 12 days' indwelling time, but not with the insertion site. Cleaning hubs with povidone-iodine protects from infection.